Wansbeck Supported Living Service

Wansbeck Supported Living Service provides personal care to people, including those with a learning disability and autistic people. People live in their own bungalow so they can live as independently as possible, and the service also provides outreach support to people who live locally. At the time of our inspection 12 people were receiving a regulated activity.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

People’s experience of using this service and what we found

Right Support

The service was not able to fully demonstrate how they were meeting the underpinning principles of Right support, right care, right culture due to the lack of knowledge by staff about this guidance.

Medicines were not always managed safely and staff were not following safe infection prevention and control (IPC) measures during the inspection. Risk assessments were completed for people. However, these had not been reviewed at the frequency identified by the provider. Systems were in place to safeguard people from abuse.

People were supported to maintain their home environment and had personalised their home to reflect their taste and preferences.

Right Care

The service did not always have enough appropriately skilled staff to meet people's needs. Staff knew people well and knew how to support people to overcome any communication barriers. Information was available to people in alternative formats to support people’s communication needs.

Staff treated people with care and kindness and supported people to take part in a range of activities. Assessments of people’s needs had been completed. However, these had not been reviewed at the time frames identified by the provider and did not always evidence people had been involved in decisions about their care or agreed to the support being provided.

Right Culture

The culture at the service was positive. Staff described ways of working which were person-centred. However, records did not always demonstrate that care plans remained relevant as they were not being regularly reviewed in line with the requirements identified by the provider.

People were encouraged to be active citizens in their local community. Feedback from people confirmed they were happy living at the service and felt safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 13 October 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. These related to safe care and treatment, staffing and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wansbeck Supported Living Service provides personal care and support to nine people with learning disabilities, autism or associated related conditions or mental health needs. Some people may have behaviours that challenge. People live in nine supported living settings, so that they can live in their own home as independently as possible. The service also provides outreach support to four people living nearby in their own homes. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection in April 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good apart from the caring domain which exceeded the fundamental standards. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People, relatives and care professionals considered the caring nature of the service to be of the highest standard. Staff knew the people they were supporting very well and we observed that care was provided with exceptional patience and kindness. Staff upheld people's human rights and treated everyone with great respect and dignity.

People were empowered to make meaningful decisions about how they lived their lives. They were supported to become as independent as possible whatever their level of need, to enable them to lead a more fulfilled life.

Records were personalised, up-to-date and accurately reflected people's care and support needs. They provided staff with detailed information to enable them to provide effective, safe and person-centred care.

People were supported to have maximum control over their lives and staff supported them in the least restrictive way possible; policies and procedures supported this practice. There was sufficient staffing capacity to provide individual care to people.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People were encouraged to maintain a healthy diet.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Systems were in place for people to receive their medicines in a safe way. Those who were able, were supported to manage their own medicines.

People were provided with opportunities to follow their interests and hobbies and they were introduced to new activities. People were encouraged and supported to go out and engage with the local community and maintain relationships that were important to them.

The provider continuously sought to make improvements to the service people received. People, relatives and staff spoke highly of the registered manager and management team and said the service had good leadership. There were effective systems to enable people to raise complaints and to assess and monitor the quality of the service.

Further information is in the detailed findings below.

Wansbeck Supported Living Service provides support to nine people with a learning disability. The service supports people to live independent lives as part of the local community in their own, self-contained, bungalows. The bungalows are situated within a residential area of Bedlington, Northumberland. At the time of the inspection there were nine people using the service.

The home had a registered manager who had been registered since October 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were aware of safeguarding issues, had undertaken training in the area and told us they would report any concerns around potential abuse. There was one current safeguarding issue being investigated. The provider was following appropriate processes and procedures. People rented their accommodation from a housing association. They were supported by staff to report any problems with the premises directly to the association.

Staffing levels were maintained to support the changing needs of people who used the service. The staff were able to support people to access the community and support them with their personal care needs. Proper recruitment procedures and checks were in place to ensure staff employed by the service had the correct skills and experience. Medicines were stored and handled correctly and safely.

Staff had access to regular training and updating of skills. Records indicated most staff had completed all mandatory training and systems were in place to monitor that training remained up to date. Staff said they were able to access the training they required. Visiting professionals told us staff had the right skills to support people. Staff told us, and records confirmed there were regular supervision sessions for all staff members and each staff member had an annual appraisal.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. Some people’s capacity was being assessed in advance of applications to the Court of Protection. The Court of Protection is a court established under the MCA and makes decisions on financial or welfare matters for people who can’t make decisions at the time they need to be made, because they may lack capacity to do so. Staff were aware of the need for best interests decisions to be made where people did not have capacity to make their own decisions. We saw appropriate action had been taken in certain circumstances.

People had access to health care services to help maintain their wellbeing. There were regular visits and checks by general practitioners and other health and social care professionals. Advice from such interventions was incorporated into people’s care records.

People were supported to access adequate levels of food and drink. Most people were supported to undertake their own shopping and, where possible, cook their own meals. Specialist advice on nutrition had been sought and guidance was followed.

People’s independence was supported and they were helped to maintain their own accommodation in a way that was safe but personal to them. We observed there to be good relationships between people and staff and people told us they were happy with the staff at the service.

Staff advocated on behalf of people using the service and described how they had supported a person to make a complaint to a retailer. Staff understood about treating people with dignity and respected people’s personal space in their own homes.

People’s needs had been fully assessed and individualised care plans and risk assessments were developed that addressed all their identified needs. Care plans had detailed information for both care staff and visiting professionals to follow. Changes to care delivery were effectively reviewed. People were supported to attend various events and activities in the local community. They told us they could also visit friends elsewhere in the service for coffee and a chat. The manager told us there had been no formal complaints in the last year and most people came to the main office for support or advice if they had a problem.

Records confirmed regular checks and audits were carried out by the service. Staff were positive about the leadership of the service and the support they got from the manager. They said there was a good staff team and felt well supported by colleagues. Questionnaires completed by people who used the service where overwhelmingly positive about the support they received. Records at the home were completed and contained good detail.

We saw that people's needs had been assessed before they started to use the service and that each file contained an assessment of needs, individual care plans and risk assessments. People told us, 'The staff are alright with me. One of the staff helped me have a bath this morning' and 'The staff are very nice. I am very happy here and you can put that in your report.' Staff we spoke with were able to describe in detail the type of care and support that people required to maintain independent lives. One staff member told us, 'This is proper care. You are blending in with their lives. You are not telling them, they are telling you what they want.'

The provider had in place policies regarding infection control and effective hand washing. Records confirmed that staff had undertaken both infection control and hand hygiene training. Staff were able to describe the actions they would take to reduce the risk of infections and contamination, when working in people's homes.

We found staff files contained evidence that appropriate processes and checks had been made in the recruitment and appointment of staff.

We saw risk assessments and care plans were subject to regular review and updated where people's needs had changed. Staff personal and training records were also up to date.